Investigator
Kagoshima University
Intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer: association for pathological factors and oncologic outcomes
To examine the association between intrauterine manipulator use and pathological factors and oncologic outcomes in patients with endometrial cancer who had laparoscopic hysterectomy in Japan. This was a nationwide retrospective cohort study of the tumor registry of the Japan Society of Obstetrics and Gynecology. Study population was 3846 patients who had laparoscopic hysterectomy for endometrial cancer from January 2015 to December 2017. An automated 1-to-1 propensity score matching with preoperative and intraoperative demographics was performed to assess postoperative pathological factors associated with the intrauterine manipulator. Survival outcomes were assessed by accounting for possible pathological mediators related to intrauterine manipulator use. Most patients had preoperative stage I disease (96.5%) and grade 1-2 endometrioid tumors (81.9%). During the study period, 1607 (41.8%) patients had intrauterine manipulator use and 2239 (58.2%) patients did not. In the matched cohort, the incidences of lymphovascular space invasion in the hysterectomy specimen were 17.8% in the intrauterine manipulator group and 13.3% in the non-manipulator group. Intrauterine manipulator use was associated with a 35% increased odds of lymphovascular space invasion (adjusted odds ratio 1.35, 95% confidence interval (CI) 1.08 to 1.69). The incidences of malignant cells identified in the pelvic peritoneal cytologic sample at hysterectomy were 10.8% for the intrauterine manipulator group and 6.4% for the non-manipulator group. Intrauterine manipulator use was associated with a 77% increased odds of malignant peritoneal cytology (adjusted odds ratio 1.77, 95% Cl 1.29 to 2.31). The 5 year overall survival rates were 94.2% for the intrauterine manipulator group and 96.6% for the non-manipulator group (hazard ratio (HR) 1.64, 95% Cl 1.12 to 2.39). Possible pathological mediators accounted HR was 1.36 (95%Cl 0.93 to 2.00). This nationwide analysis of predominantly early stage, low-grade endometrial cancer in Japan suggested that intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer may be associated with an increased risk of lymphovascular space invasion and malignant peritoneal cytology. Possible mediator effects of intrauterine manipulator use on survival warrant further investigation, especially with a prospective setting.
Comparison of laparoscopic and robotic-assisted minimally invasive surgery with sentinel lymph node navigation in low-risk endometrial cancer: a retrospective analysis
To evaluate and compare the perioperative and oncologic outcomes of laparoscopic and robotic-assisted surgeries in patients with low-risk endometrial cancer who underwent minimally invasive surgery (MIS) for complete surgical staging, including sentinel lymph node mapping. A retrospective study included 190 patients diagnosed with low-risk endometrial cancer who underwent MIS combined with sentinel lymph node navigation surgery (SNNS) between December 2016 and December 2021. Among these patients, 66 underwent laparoscopic surgery, while 124 underwent robotic-assisted surgery. The analysis focused on patient characteristics, perioperative outcomes, and prognostic factors, including recurrence-free survival (RFS) and overall survival (OS). Statistical analysis was performed using Kaplan-Meier survival curves and appropriate comparative tests for outcome evaluation. The median operative time and estimated blood loss were significantly longer and greater in the robotic surgery group than in the laparoscopic group (209.5 vs. 157.5 min, 20 vs. 5 mL, respectively). The identification rates of sentinel nodes were 97% and 95.2% in the laparoscopic and robotic groups, respectively, with no significant difference between the 2. Recurrence was observed in two and three cases in the laparoscopic robotic surgery groups, respectively. The 3-year RFS rates were 97.6% (95% confidence interval [CI]=0.8482-0.9769) and 93.9% (95% CI=0.9277-0.9922) for the robotic and laparoscopic groups, respectively, while the 3-year OS rates were 99.2% (95% CI=0.8561-0.9902) and 96.1% (95% CI=0.9450-0.9989), respectively, with no statistically significant differences. MIS combined with SNNS is a highly effective approach for managing low-risk endometrial cancer, providing comparable oncologic outcomes to laparoscopy while enhancing the quality of life of patients.
Molecular biological analysis revealed a case of synchronous endometrial and ovarian cancer with different histological grade as metastatic ovarian cancer from endometrial cancer: Case report and review of literature
AbstractThe diagnosis of synchronous endometrial and ovarian cancer or metastatic cancer of the same histological type is difficult. In this study, molecular biology analysis was performed to determine ovarian metastasis from endometrial cancer. A 38‐year‐old woman had pathological evidence of endometrial cancer (endometrioid carcinoma, grade 1) and ovarian cancer (endometrioid carcinoma, grade 3); a disseminated nodule in the serosa uteri was also diagnosed as endometrioid carcinoma (grade 3). Customized panel sequencing revealed a common mutation pattern in ovarian cancer and disseminated nodules. Furthermore, endometrial cancer showed the same mutation patterns for FGFR3 and PTEN as ovarian cancer and disseminated nodules. All tumors were microsatellite instability high. Clinicopathological and molecular biology analyses suggested that the patient had ovarian metastasis from endometrial cancer. The patient underwent adjuvant chemotherapy with paclitaxel and carboplatin, with no recurrence. Molecular biology techniques may enable appropriate treatment based on clinically accurate diagnosis.
Impact of obesity on the outcomes and cost of robotic surgery for Stage IA endometrial cancer: a regional perspective from Japan
Abstract Background The incidence of endometrial cancer in Japan has more than doubled over the past 2 decades because of increasing obesity rates and the unique physiological traits of Asian populations. The aim of this retrospective study was to examine the impact of obesity on surgical outcomes, prognosis, and costs. Methods A total of 197 patients with stage IA endometrial cancer who underwent robot-assisted hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy/biopsy from 2018 onward were included. Patients were divided into the BMI < 30 kg/m 2 group (n = 117) and the BMI ≥ 30 kg/m 2 group (n = 80). The clinical and pathological factors, surgical outcomes, perioperative complications, and treatment costs were compared. The median follow-up period was 34.9 months (range: 6.1–84.2). Results In the BMI ≥ 30 kg/m 2 group, significant differences in comorbidities, including diabetes mellitus (19.7% vs. 51.3%), hypertension (43.6% vs. 58.8%), and hyperlipidemia (29.9% vs. 50%), were detected. However, no significant differences were found in operative time, blood loss volume, perioperative complication rates, or 5-year cancer-specific survival rates (97.6% vs. 100%). Surgical and hospitalization costs were higher in the BMI ≥ 30 kg/m 2 group, indicating a financial burden for both patients and healthcare facilities. Additionally, a higher prevalence of newly developed lifestyle-related diseases, such as cardiovascular diseases and diabetes, was observed during the follow-up (2.5% vs. 10%). Conclusions While obesity (BMI ≥ 30) did not significantly impact surgical outcomes or cancer prognoses, it did increase treatment costs and the risk of lifestyle-related diseases. Thus, preventive strategies, including lifestyle counseling, are needed to reduce obesity-related health burdens.
Efficacy and prognosis of robotic surgery with sentinel node navigation surgery in endometrial cancer
This study aimed to validate the surgical and oncologic outcomes of robotic surgery with sentinel node navigation surgery (SNNS) in endometrial cancer. This study included 130 patients with endometrial cancer, who underwent robotic surgery, including hysterectomy, bilateral salpingo-oophorectomy, and pelvic SNNS at the Department of Obstetrics and Gynecology of Kagoshima University Hospital. Pelvic sentinel lymph nodes (SLNs) were identified using the uterine cervix 99m Technetium-labeled phytate and indocyanine green injections. Surgery-related and survival outcomes were also evaluated. The median operative and console times and volume of blood loss were 204 (range: 101-555) minutes, 152 (range: 70-453) minutes, and 20 (range: 2-620) mL, respectively. The bilateral and unilateral pelvic SLN detection rates were 90.0% (117/130) and 5.4% (7/130), respectively, and the identification rate (the rate at which at least one SLN could be identified on either side) was 95% (124/130). Lower extremity lymphedema occurred in only 1 patient (0.8%), and no pelvic lymphocele occurred. Recurrence occurred in 3 patients (2.3%), and the recurrence site was the abdominal cavity, with dissemination in 2 patients and vaginal stump in one. The 3-year recurrence-free survival and 3-year overall survival rates were 97.1% and 98.9%, respectively. Robotic surgery with SNNS for endometrial cancer showed a high SLN identification rate, low occurrence rates of lower extremity lymphedema and pelvic lymphocele, and excellent oncologic outcomes.
A potential inflammatory biomarker for advanced endometrial cancer treated with lenvatinib plus pembrolizumab
AbstractIntroductionTo identify prognostic biomarkers that could predict how well patients will respond to lenvatinib/pembrolizumab (LEN/PEM). The utility of certain inflammatory biomarkers in endometrial liquid‐based cytology (LBC) or peripheral blood samples, such as neutrophil counts, lymphocyte counts, and neutrophil‐to‐lymphocyte ratio (NLR) were explored.MethodsThe study included 25 patients with advanced or recurrent endometrial cancer who had received LEN/PEM between August 2018 and March 2024. Predictors for overall response (OR), disease control, and progression‐free survival, based on neutrophil/lymphocyte counts, NLR scores of the endometrial LBC prior to initial treatment, and peripheral blood prior to initial treatment and prior to LEM/PEM treatment were compared using a receiver operating characteristic curve. Significant predictors were evaluated using the log‐rank test, and multivariate analysis.ResultsAlthough neutrophil counts and NLR score in endometrial LBC prior to initial treatment were better effective predictors for OR, the most accurate predictor of a progression‐free status was NLR score in peripheral blood prior to LEM/PEM (0.722, 95% CI: 0.45–0.99, sensitivity: 57.1%, specificity: 94.4%). In peripheral blood prior to LEN/PEM, the lower NLR (NLR <5.39) group had a significantly longer PFS than the higher NLR (5.39 ≤ NLR) group (p = 0.023, median survival: 13.5 vs. 3.0 months), and tended to be independently correlated with PFS (hazard ratio = 2.571; 95% CI = 0.857–7.719; p = 0.092).ConclusionInflammatory biomarkers in endometrial LBC failed to predict the efficacy of LEN/PEM, while peripheral blood NLR score sampled prior to LEN/PEM potentially could be a significant predictor.
Trend and characteristics of minimally invasive surgery for patients with endometrial cancer in Japan
Owing to the potential benefits of minimally invasive hysterectomy for endometrial cancer, the practice pattern has recently shifted in Japan. This study examined the trends in minimally invasive surgery (MIS) in patients with endometrial cancer in Japan. This retrospective observational study examined the Japan Society of Obstetrics and Gynecology Tumor Registry database between 2015-2019. This study examined the time-specific proportion change and predictors of MIS use in initial endometrial cancer treatment in Japan, and compared it with the use of abdominal surgery. Additionally, the association between hospital surgical treatment volume and MIS use was examined. A total of 14,059 patients (26.5%) underwent minimally invasive hysterectomy, and 39,070 patients (73.5%) underwent abdominal hysterectomy in the study period. Patients who underwent MIS were more likely to be treated at high-volume centers, younger, central, or western Japan residents, registered in recent years, and had a tumor with stage I disease, type 1 histology, and less myometrial invasion (all adjusted p<0.05). The proportion of MIS treatments increased from 19.1% in 2015 to 34.3% in 2019 (p<0.001). On multivariable analysis, treatment at high-volume centers was a contributing factor for MIS (adjusted odds ratio=3.85; 95% confidence interval=3.44-4.30). MIS at high-volume centers increased significantly from 24.8% to 41.0% (p<0.001) during the study period, whereas MIS at low-volume centers remained at median 8.8%. MIS has increased significantly in recent years, accounting for nearly 34% of surgical management of endometrial cancer in Japan. High-volume treatment centers take the lead in performing MIS.
Cytopathological features associated with POLE mutation in endometrial cancer
AbstractObjectiveFor patients with endometrial cancer, the POLE (polymerase epsilon) mutation (POLEmut)‐subtype, one of four molecular‐analysis‐based categories in the Cancer Genome Atlas (TCGA), has the best prognosis. The following histological characteristics are typically observed in endometroid carcinoma cases with the POLEmut‐subtype: (1) the presence of tumour giant cells, (2) numerous tumour‐infiltrating lymphocytes (TILs) and/or peri‐tumoral lymphocytes, and (3) a high grade. However, in the context of cytology, the morphological characteristics of this subtype remain unknown.MethodsDNA extracted from formalin‐fixed paraffin‐embedded (FFPE) tissues was subjected to next‐generation sequencing analysis and categorised according to the TCGA classifications. Genomic mutation, tumour mutation burden (TMB), and microsatellite instability were also assessed. Cytological specimens of resected uteri obtained using the Papanicolaou method were histologically separated into three types.ResultsSeven out of 112 patients (6%) with endometrial cancer were diagnosed with the POLEmut‐subtype between January 2019 and August 2021. Tumour giant cells were observed in three cases (43%) on histology and cytology. TIL and/or peritumoral lymphocytes with inflammatory cells were detected in five cases (71%) on histology and three cases (43%) on cytology. Cases in which these three characteristics were observed on both cytology and histology may have belonged to the POLEmut‐subtype. There were no cases in which these characteristics were absent on histology but present on cytology. TMB tended to be higher in cases when the three characteristics were observed in both cytological and histological findings.ConclusionsPreoperative endometrial cytology highlighted the characteristics of the POLEmut‐subtype in the histological analysis of resected uterine specimens and has the potential to play an important role in treatment decisions.
One-step nucleic acid amplification (OSNA) assay for detecting lymph node metastasis in cervical and endometrial cancer: a preliminary study
To evaluate the accuracy of the one-step nucleic acid amplification (OSNA) assay for the diagnosis of lymph node (LN) metastasis in uterine cancer. A total of 116 LNs from 30 patients with cervical and endometrial cancer, enrolled in this prospective study, were used. Excised LNs were cut into 4 to 6 blocks at 2 mm intervals, and nonadjacent blocks were alternately subjected to either histological examination or the OSNA assay. The concordance rate between histological examination and the OSNA assay in cervical cancer and in endometrial cancer was 95.9% and 95.2%, respectively. The sensitivity, specificity, and negative predictive value of the OSNA assay were 80%, 97.7%, and 97.7% in cervical cancer, and 85.7%, 93.3%, and 98.2% in endometrial cancer, respectively. In cervical cancer, discordant results were observed in 2 out of 49 LNs (4.1%); 1 was OSNA assay-positive and histological examination-negative, and 1 was OSNA assay-negative and histological examination-positive. In endometrial cancer, discordant results were observed in 5 out of 67 LNs (7.5%); 4 were OSNA assay-positive and histological examination-negative, and 1 was OSNA assay-negative and histological examination-positive. The OSNA assay showed high concordance rate with histological examination, sensitivity, and specificity in uterine cancer, suggesting that it could enhance the accuracy of conventional pathological examination for the detection of LN metastasis by reducing false negative rate.
Fertility‐Sparing Trachelectomy With Sentinel Node Mapping in Early‐Stage Cervical Cancer: Oncological Safety and Obstetric Outcomes From a Single‐Institution Study
ABSTRACT Aim Trachelectomy is a fertility‐preserving surgical approach for early‐stage cervical cancer. To enhance oncological safety, intraoperative sentinel lymph node (SN) evaluation has been incorporated. This study aimed to evaluate the long‐term oncological and obstetric outcomes of trachelectomy with SN biopsy. Methods We enrolled 53 patients who underwent trachelectomy with intraoperative SN assessment at Kagoshima University Hospital between 2014 and 2022. The preoperative and intraoperative eligibility criteria were strictly applied. Surgical and obstetric outcomes were evaluated, and recurrence‐free survival (RFS) and overall survival (OS) were calculated using the Kaplan–Meier analysis. Results Among the 78 candidates, 53 met all criteria and successfully underwent trachelectomy. The 5‐year RFS and OS rates were both 98%. Bilateral SNs were detected in 98% of patients, and intraoperative SN biopsy‐guided surgical decisions were made. Postoperative complications occurred in 6% of the patients. Of the 19 patients who attempted conception, 10 (53%) became pregnant, leading to 8 live births (five preterm, three term). In vitro fertilization and embryo transfer were used in 60% of the pregnancies. Pregnancy was associated with a high risk of preterm delivery. Conclusions Trachelectomy with intraoperative SN biopsy is a feasible and safe treatment option for appropriately selected patients with early‐stage cervical cancer. It offers excellent oncological outcomes and acceptable fertility potential. However, the risk of obstetric complications, particularly preterm births, remains high. Structured postoperative and perinatal management is crucial. Further prospective multicenter studies are warranted to validate and refine this approach.
Robotic dual-docking surgery for para-aortic lymphadenectomy in endometrial cancer: a prospective feasibility study
Abstract Background The standard for robotic para-aortic lymphadenectomy has not been fully established. Para-aortic lymphadenectomy performed by sharing the same ports with pelvic procedures, a procedure known as dual-docking surgery, can be performed using the latest robotic system. We prospectively examined the ability of standardized dual-docking robotic surgery in endometrial cancer patients. Methods This study prospectively verified the feasibility and safety of dual-docking robotic surgeries performed between March 2017 and December 2021. The laterally placed ports were aligned with the umbilicus. Primary outcome was the surgical completion rate; secondary outcomes were blood loss, operative time, unexpected port placement, conversion, complications, length of hospital stay, and survival. Results Most patients (14/15, 93%) underwent surgery using our methods without additional port placements, and one patient was converted to laparotomy. Median blood loss was 162 mL (range: 20–685 mL). Median operative time was 183 and 206 min in the upper and lower abdomen. Median number of resected para-aortic lymph nodes was 19 (range: 6–29), and pelvic lymph nodes was 28 (range: 15–42). Although there was no difficulty in moving the forceps intraoperatively, major complications including vessel injury, and pelvic abscesses were observed. The lateral ports could be placed 6–10 cm apart in patients with any range of body type. Conclusion Dual-docking surgery for endometrial cancer has the potential to be a standard procedure for robotic endometrial cancer surgery, although a greater number of cases are needed to acquire proficiency.
Malignant peripheral nerve sheath tumor of the cervix in an adolescent with neurofibromatosis type 1: A case report and review of literature
AbstractMalignant peripheral nerve sheath tumors (MPNSTs) of the cervix are rare, particularly in patients with neurofibromatosis type 1 (NF1). This report describes a cervical MPNST in an 18‐year‐old patient with no history of sexual activity, abnormal vaginal discharge, and prolonged menstruation. She had more than six café‐au‐lait spots on her body since birth and was diagnosed with NF1 at 2 years of age. Positron emission tomography‐computed tomography revealed a large pelvic mass and lung and bone metastases. Biopsy confirmed MPNST. Immunohistochemical staining showed diffuse positivity for CD10, approximately 30% positivity for cyclin D1, partial positivity for α‐SMA, desmin, and MyoD1, and negativity for myogenin, S‐100, and SOX‐10. A cancer gene panel identified several genetic abnormalities, but none were actionable mutations. Despite systemic chemotherapy, the tumor progressed rapidly, and the patient died 8 weeks post‐admission. Early diagnosis of MPNST is crucial. In patients with NF1, even mild symptoms can indicate MPNST.
Challenges in managing atypical glandular cells in cervical smears: Insights from real‐world data and clinicians' perspectives
AbstractObjectiveThis study evaluates clinicopathological outcomes and clinicians' awareness regarding the management of atypical glandular cells (AGC).MethodsWe analyzed 98 AGC cases, excluding known endometrial cancer, from 238 initial cases, with a median age of 42 years (range 20–82). Cytological findings, including NOS and FN subcategories, diagnostic tests, treatments, and outcomes were evaluated. A survey on AGC awareness and practices was conducted among 134 obstetrician‐gynecologists.ResultsOf 98 cases (AGC‐FN: 19.8%, AGC‐NOS: 13.2%, unspecified: 67.3%), 44.9% initially showed no neoplasia; this dropped to 38.8% following up, identifying 11 additional AIS or cervical adenocarcinomas. Overall, 28.5% had AIS or more, 18% had CIN, and 13.3% had other malignancies, indicating some over/underdiagnosis. HPV testing in 79 cases showed a 48.1% positivity rate, including 14 type‐18 and 12 type‐16 cases. Among clinicians surveyed, 25% were aware of AGC subcategories, and only 11.9% were well‐versed. Approximately 65% associated AGC with malignancy or precancerous lesions, and 52.6% used multiple diagnostic methods simultaneously. Even in the absence of neoplasia, 80% continued cytological examinations every 3–4 months.ConclusionThis study underscores the challenges in AGC management, highlighting the importance of follow‐up and collaboration between clinicians and cytopathologists to detect significant lesions. It also emphasizes the need for providing learning opportunities for clinicians to address over/undertreatment.
Robotic trachelectomy with sentinel lymph node biopsy for cervical cancer: a prospective study investigating minimally invasive radicality
Abstract Objective The importance of minimally invasive fertility-sparing surgery for cervical cancer is gaining increasing interest, both to achieve a cure and for future fertility. Procedures for robotic radical trachelectomy involving uterine reconstruction are not fully established. Methods This study prospectively verified the feasibility and safety of robotic radical trachelectomy between February 2018 and May 2022. The criteria were almost identical to those for our standard abdominal radical trachelectomy. Larger tumors (> 2 cm in diameter) were acceptable for surgery, provided a secure ≥ 1 cm cancer-free space was identified between the tumor and internal os. Results Eight patients (median age, 32 y) were registered; the median body mass index was 21.8, and the median tumor size was 11.5 mm (range 0–30 mm). Robotic radical trachelectomy could be achieved in all patients with hybrid sentinel lymph node navigation surgery, confirming the precise cervical amputation line with a newer small knob ultrasonography probe, adequate cervical cerclage with non-absorbable monofilament stitches, and avoiding looseness between vaginal–uterine anastomosis with uninterrupted barbed U-shaped sutures. None of the cases were converted to laparotomy or radical hysterectomy, and there were no major complications. The median follow-up period was 49.5 mo (range 21–58 mo) and no patient had disease recurrence. Conclusion Robotic radical trachelectomy is safe and feasible using newer technologies without reducing radicality; it is also less invasive. Procedures are consistently reproducible and have the potential to be generalized to minimally invasive approaches.
Long-term outcomes of sentinel lymph node navigation surgery for early-stage cervical cancer
Abstract Background Sentinel lymph node navigation surgery, which identifies the sentinel lymph node in early cervical cancers and omits systemic pelvic lymphadenectomy in cases where no lymph node metastasis is present, has recently gained attention. However, there are few reports on lymph node recurrence and the long-term outcomes of cervical cancer surgery performed using sentinel lymph node navigation surgery. In this study, we aimed to evaluate the long-term outcomes of sentinel node navigation surgery for early-stage cervical cancer. Methods One hundred thirty-eight patients with cervical cancer were enrolled. Sentinel lymph nodes were identified by injecting 99 m Technetium-labeled phytate and indocyanine green into the uterine cervix. Surgery and survival outcomes were also analyzed. Results The median age and body mass index of the patients were 40 years (20–78) and 21.7 kg/m2 (16.5–50.4), respectively. Open surgery, laparoscopic surgery, and robotic surgery were performed in 77 (56%), 53 (38%), and 8 (6%) patients, respectively. The overall and bilateral detection rates of the sentinel lymph node were 100% and 94%, respectively. Only one case (0.7%) exhibited lower extremity lymphedema, and pelvic lymphocele was observed in three cases (2.2%). Four cases (3%) experienced recurrence over a median follow-up of 57.5 months (range, 2–115 months), with five-year recurrence-free and overall survival rates of 97% and 97.3%, respectively. Conclusions Our results demonstrate that sentinel node navigation surgery may be safe and effective for early-stage cervical cancer.
Validation of single‐photon emission computed tomography with computed tomography and lymphoscintigraphy for sentinel lymph node identification in cervical cancer
AbstractObjectiveTo compare single‐photon emission computed tomography with computed tomography (SPECT/CT) and lymphoscintigraphy (LSG) for the detection of sentinel lymph nodes (SLNs) in patients with early‐stage cervical cancer.MethodsThis hospital‐based, single‐center, retrospective study included 128 patients with cervical cancer (aged >18 years) treated between 2014 and 2022. Injection of 99 m Technetium‐labeled phytate into the uterine cervix was used to detect pelvic SLNs. SNL identification rates and locations were analyzed for preoperative LSG and SPECT/CT.ResultsMedian age and body mass index of patients were 40 years (range, 20–78 years) and 21.7 kg/m2 (range, 16–40 kg/m2), respectively. There was no significant difference in overall identification rates (identification of at least one SLN) of SLNs between SPECT/CT (91%) and LSG (88%). There was no significant difference in bilateral SLN identification rates between SPECT/CT (66%) and LSG (65%). A total of 219 pelvic SLNs (110 right and 109 left hemipelvis) were identified by SPECT/CT; the most frequent locations were the obturator (122 SLNs, 56%) and external iliac (67 SLNs, 30%).ConclusionSPECT/CT and LSG showed high SLN identification rates in patients with cervical cancer, and there was no significant difference in overall or bilateral SLN identification rates between the two techniques.
Segmental Renal Infarction Associated with Accessory Renal Arteries After Para-Aortic Lymphadenectomy in Gynecologic Malignancies
Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography (CECT). Materials and Methods: This retrospective study investigated a clinical database to identify urinary contrast defects using CECT in all patients who had undergone PANDx between January 2020 and December 2024. The perfusion defects in the kidney detected by CECT were extracted by a gynecologic oncologist and evaluated by a radiologist and urologist for suspected obstruction of ARAs. Results: Postoperative renal contrast defects were observed in 3.8% (6/157) of patients. Renal parenchymal fibrosis, cortical atrophy, and parenchymal thinning were observed as universal findings in all patients showing renal contrast defects. In five of the six cases, ARAs supplying the infarcted renal segments were identified on preoperative CECT, and arterial obstruction was confirmed on postoperative imaging. The remaining case was considered to be latent pyelonephritis. All five patients underwent laparotomy, and preoperative CECT failed to detect ARAs. The median resected para-aortic lymph node was 23 nodes (range: 15–33) in five patients, showing no statistically significant difference compared to patients without perfusion abnormalities (p = 0.19). Postoperative serum creatinine levels remained stable. Conclusions: ARA obstruction appears to be a risk factor for segmental renal infarction after para-aortic lymphadenectomy in gynecological malignancies; however, the clinical impact on urinary function may be limited. Awareness of this potential complication is essential for gynecologic oncologists performing PANDx.
Potential preoperative three‐dimensional computed tomography for para‐aortic lymphadenectomy in gynecological malignancies
Abstract Background The evaluation of anatomical abnormalities involving urinary vessel variations prior to para‐aortic lymphadenectomy in gynecological malignancies is challenging. In this context, the utility of preoperative three‐dimensional (3D) computed tomography (3DCT) angiography in improving surgical outcomes was examined. Methods This retrospective study evaluated the utility of 3DCT in patients who underwent para‐aortic lymphadenectomy between January 2023 and November 2024. 3D fusion images were constructed from the arterial phase, CT‐venography, and CT‐urography. A total of 72 patients were included and divided into two groups: non‐3DCT and 3DCT. Outcomes included detection rates of arterial, venous, or urinary tract variations and surgical outcomes, including complications, in both groups. Results The 3DCT group included 14/34 (41.2%) cases with renal vessel variations and two cases (5.9%) with double ureters; the non‐3DCT group did not detect any anatomical abnormalities. In the 3DCT group, renal vessel and urinary tract variations were clearly shown. Postoperative complications tended to be slightly higher in the non‐3DCT group, including lymphocyte infection, chylous leakage, and bowel obstruction. Postoperative CT revealed reduced contrast in the lower pole of the right kidney in the 3DCT case with the most complex urinary vessel variations. Furthermore, in the 3DCT group, 8/34 (23.5%) unilateral or bilateral renal arteries were located caudally to the lower edge of the renal vein. Conclusion In gynecological malignancies, 3DCT before para‐aortic lymphadenectomy seems superior in identifying urinary vessel variations over conventional contrast‐enhanced CT; thus, aiding realistic preoperative simulations and potentially reducing surgeons' burden and perioperative complications.
Tisotumab vedotin in Japanese patients with recurrent or metastatic cervical cancer: results from the innovaTV 301/ENGOT-cx12/GOG-3057 trial
Tisotumab vedotin resulted in significantly longer overall survival compared with chemotherapy as second- or third-line therapy for recurrent or metastatic cervical cancer in the phase III, multi-national, open-label innovaTV 301/ENGOT-cx12/GOG-3057 trial. We report the results of a sub-group analysis of enrolled Japanese patients. Patients were randomized 1:1 to tisotumab vedotin or investigator-choice chemotherapy (topotecan [nogitecan hydrochloride], vinorelbine, gemcitabine, irinotecan, or pemetrexed). The primary end point was overall survival. Among 502 randomized patients, 101 were Japanese (tisotumab vedotin, n = 50; chemotherapy, n = 51). With 13.7 months of median follow-up in Japanese patients, median overall survival was 15.0 months (95% confidence interval [CI] 9.7 to not estimable) with tisotumab vedotin and 8.5 months (95% CI 6.8 to 10.6) with chemotherapy, representing a 55% lower risk of death with tisotumab vedotin than chemotherapy (hazard ratio 0.45, 95% CI 0.27 to 0.77). Median progression-free survival was 4.0 months (95% CI 3.0 to 4.4) with tisotumab vedotin and 2.0 months (95% CI 1.5 to 3.0) with chemotherapy (hazard ratio 0.63, 95% CI 0.42 to 0.95). The confirmed objective response rate was 24.0% (95% CI 13.1 to 38.2) with tisotumab vedotin and 2.0% (95% CI 0.0 to 10.4) with chemotherapy. All patients in the tisotumab vedotin and chemotherapy arms had ≥1 treatment-emergent adverse event; grade ≥3 events occurred in 42.9% and 66.0%, respectively. Six patients (12.2%) discontinued tisotumab vedotin due to treatment-emergent adverse events. Consistent with global findings, tisotumab vedotin resulted in clinical improvement compared with chemotherapy across all efficacy end points, and demonstrated a manageable adverse event profile in Japanese patients with recurrent or metastatic cervical cancer.
